Non-pharmaceutical therapies for stroke: Mechanisms and clinical implications

Article ID	Journal	Published Year	Pages	File Type
6286512	Progress in Neurobiology	2014	24 Pages	PDF

Abstract

Stroke is deemed a worldwide leading cause of neurological disability and death, however, there is currently no promising pharmacotherapy for acute ischemic stroke aside from intravenous or intra-arterial thrombolysis. Yet because of the narrow therapeutic time window involved, thrombolytic application is very restricted in clinical settings. Accumulating data suggest that non-pharmaceutical therapies for stroke might provide new opportunities for stroke treatment. Here we review recent research progress in the mechanisms and clinical implications of non-pharmaceutical therapies, mainly including neuroprotective approaches such as hypothermia, ischemic/hypoxic conditioning, acupuncture, medical gases and transcranial laser therapy. In addition, we briefly summarize mechanical endovascular recanalization devices and recovery devices for the treatment of the chronic phase of stroke and discuss the relative merits of these devices.

Keywords

CREB NF-κB MMP HPC NBO FeS NADPH ACP COX-2 Bcl-2 ERK MRS TCM iNOS PPARγ RNS hsp70 eNOS AMPA iAs pKa IκB CBF tDCS NMDA N-methyl-d-aspartate MCAO HbO nNOS DWI PKC IPC BCI TIA PGC-1α IKK PO2 GSK3β HIF α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid VNS NIHSS GluR2 SphK rtPA ROSC ENT1 PI3-kinase Glutamate receptor 2 FDA rTMS heat shock 70 kDa protein inhibitor of NF-κB kinase TLT BDNF MAPK Hypoxic preconditioning ROS δ-Opioid receptor Sphingosine kinase gamma-aminobutyric acid Electro-acupuncture Ames middle cerebral artery occlusion hyperbaric oxygen therapy Ischemia Return of spontaneous circulation Transcranial direct current stimulation Functional electrical stimulation vagus nerve stimulation Repetitive transcranial magnetic stimulation diffusion-weighted imaging intracranial arterial stenosis tumor necrosis factor α cerebral blood flow Equilibrative nucleoside transporter 1 transient ischemic attack DADLE DOR Brain–computer interface World Health Organization Food and Drug Administration BBB Blood–brain barrier inducible nitric oxide synthase endothelial nitric oxide synthase neuronal nitric oxide synthase Stroke Stroke Therapy Academic Industry Roundtable Cyclooxygenase-2 traditional Chinese medicine brain derived neurotrophic factor Hypoxia Inducible Factor TNF-α nuclear factor-κB Phosphatidylinositol 3-kinase Recombinant tissue plasminogen activator Nest B-cell lymphoma-2 National Institutes of Health stroke scale matrix metalloproteinase Neuroprotection Modified Rankin scale inhibitor of NF-κB Nitrite Plus Nitrate nicotinamide adenine dinucleotide phosphate Phosphatase and tensin homologue antegrade cerebral perfusion cyclic adenosine monophosphate response element binding protein protein kinase A extracellular regulated protein kinases Protein kinase C mitogen-activated protein kinase ischemic postconditioning Stair Pten WHO GABA Glycogen synthase kinase-3β reactive nitrogen species Reactive oxygen species peroxisome proliferator-activated receptor γ